Chemo-somatosensory evoked potentials: a sensitive tool to assess conditioned pain modulation?

UNLABELLED: Abstract Background: Chemo-somatosensory evoked potentials (CSSEPs) elicited by chemical stimulation (CO2 gas) of the nasal mucosa have been shown to be sensitive enough to pick up even weak analgesic effects. With the present study we wanted to investigate whether CSSEPs are also a sensitive tool to capture endogenous pain inhibitory mechanisms elicited by conditioned pain modulation (CPM; where a first conditioning stimulus reduces the sensitivity for a second test stimulus) with a conditioning stimulus of rather low noxious load. METHODS: Seventeen healthy participants were tested for CPM effects (conditioning stimulus: tonic heat pain with intensities around the pain threshold induced via a thermode; test stimulus: chemonasal stimulation (73% and 78% CO2)) on CSSEPs and on self-report ratings. RESULTS: We found significant CPM effects in the CSSEPS, with reduced amplitudes and prolonged latencies at several electroencephalogram (EEG) recording positions when using the lower CO2 concentration (73% CO2). In contrast to the visible inhibitory effects on the CSSEPs, subjective ratings of the test stimulus did not reflect CPM action. DISCUSSION: The experimental pain model using CO2 stimuli to elicit CSSEPs proved to be sensitive enough to capture weak CPM effects elicited by a conditioning stimulus of rather low noxious load. The usage of such mild noxious conditioning stimuli-in contrast to stimuli of higher noxious load (e.g., cold pressor test)-has the advantage that the activation of other types of pain inhibitory mechanisms in parallel (like attentional distraction, stress-induced analgesia) can be avoided.

Bilateral hyperalgesia to chemical stimulation of the nasal mucosa following unilateral inflammation.

The aim of the present study was to investigate the bilateral sensory changes to chemical noxious stimuli in the trigeminally innervated areas following unilateral nasal inflammation. Twenty healthy volunteers took part in five experiments. Intranasal inflammation was induced by means of a constant flow of cold air (145 ml/s); temperature and humidity of the airstream were varied across experiments. For the non-inflamed (NOI) condition, air temperature was 36 degrees C and its humidity 80%. In the other experiments the airstream's humidity was either 25% or 80% with a constant temperature of 20 degrees C; the airstream was applied to the left or right nostril. In order to produce noxious chemical stimuli, gaseous CO2 was applied to the left nostril (36 stimuli of 200 ms; 65% v/v CO2; interstimulus interval 30 s). Subjects rated the pain intensity of the stimuli by means of a visual analogue scale (VAS). As an indicator for hyperalgesia, the subjective pain ratings to CO2 stimuli increased not only while they were applied at the inflamed site, but also during their application contralaterally to the inflamed side. These results demonstrate the occurrence of bilateral hyperalgesia to noxious chemical stimuli in the nasal mucosa following unilateral inflammation which indicates the involvement of central changes.

Pain in the trigeminal system: irritation of the nasal mucosa using short- and long-lasting stimuli.

The paper describes methods which allow intranasal irritation using short- and long-lasting painful stimuli in humans. Short-lasting pain is induced by gaseous CO(2), while long-lasting pain is induced by a stream of dry air. Both models have been explored regarding their major determinants, e.g. stimulus duration, stimulus intensity, or repeated stimulation. Short-lasting, non-inflammatory pain stimuli seem to provide specific indicators of A(delta)-fiber function, while responses to long-lasting, inflammatory pain appear to be indicative of C-fiber function. Responses to both types of painful stimuli are modulated by analgesic drugs. As these well-investigated models allow the detailed and precise analysis of modulatory effects on intranasal nociception, they appear to be suited for the investigation of subtle changes of intranasal irritation, e.g. induced by environmental agents.

Areas of capsaicin-induced secondary hyperalgesia and allodynia are reduced by a single chiropractic adjustment: a preliminary study.

INTRODUCTION: The aim of the study was to investigate the hypoalgesic effects of a single spinal manipulation treatment on acute inflammatory reactions and pain induced by cutaneous application of capsaicin. METHODS: Twenty healthy subjects participated in the experiment, which consisted of 2 sessions. In both sessions, following control measurements, topical capsaicin was applied to the right or left forearm to induce cutaneous inflammatory reactions. The cream was removed after 20 minutes. Then subjects received either spinal manipulation treatment (SMT) or "nonspinal manipulation treatment" (N-SMT), respectively. In control as well as pretreatment and posttreatment intervals, the following tests were performed: measurement of the areas of mechanical hyperalgesia and stroking allodynia, assessment of spontaneous pain, and measurement of blood flow. RESULTS: The results confirmed that topical capsaicin induced inflammatory reactions based on occurrence of hyperalgesia and allodynia, augmented pain perception, and increased blood flow following capsaicin application compared with the control session. When compared with N-SMT, spontaneous pain was rated significantly lower post-SMT (P <.014). In addition, areas of both secondary hyperalgesia and allodynia decreased after SMT (hyperalgesia: P <.007; allodynia: P <.003). However, there was no significant treatment effect for local blood flow. CONCLUSION: These results suggest hypoalgesic effects following a single SMT. As local vascular parameter was not affected by the single SMT, the hypoalgesic effects appear to be due to central mechanisms.